Accuracy Of Procalcitonin Research Articles

Evaluation of Serial Procalcitonin Levels for the Optimization of Antibiotic Use in Non-Critically Ill COVID-19 Patients.

Procalcitonin (PCT) has been used as a biomarker to guide antibiotic therapy in various patient populations. However, its role in optimizing antibiotic use in COVID-19 patients has not been well studied to date. Thus, we aimed to evaluate the use of serial PCT monitoring as an antimicrobial stewardship tool for COVID-19 patients. This retrospective study included 240 COVID-19 patients who were admitted to a tertiary medical institution in Saudi Arabia between January 2020 and February 2022. Patients who received empiric antibiotic therapy for community-acquired pneumonia (CAP) and had serial procalcitonin levels were included. The patients were divided into two groups: the normal procalcitonin arm (PCT level < 0.5 ng/mL) and the elevated PCT arm (PCT level > 0.5 ng/mL). The primary and secondary outcomes were the effect of PCT monitoring on the duration of antibiotic exposure and the length of hospital stay, respectively. To measure the accuracy of PCT, the receiver-operating characteristic area under the curve (ROC-AUC) was determined. Among the included patients, 142 were in the normal procalcitonin arm (median PCT, 0.12 ng/mL), and 78 were in the elevated PCT arm (median PCT, 4.04 ng/mL). The baseline characteristics were similar between the two arms, except for the higher prevalence of kidney disease in the elevated PCT arm. There was no statistically significant difference in the duration of antibiotic exposure between the normal and elevated PCT arms (median duration: 7 days in both arms). However, the length of hospital stay was significantly shorter in the normal PCT arm (median stay, 9 days) than in the elevated PCT arm (median stay, 13 days; p = 0.028). The ROC-AUC value was 0.54 (95% CI: 0.503-0.595). Serial PCT monitoring did not lead to a reduction in the duration of antibiotic exposure in COVID-19 patients. However, it was associated with a shorter hospital stay. These findings suggest that PCT monitoring may be useful for optimizing antibiotic use and improving outcomes in COVID-19 patients. While PCT-guided algorithms have the potential to enable antibiotic stewardship, their role in the context of COVID-19 treatment requires further investigation.

Diagnostic accuracy of procalcitonin in adult non-neutropenic cancer patients with suspected infection: a systematic review and meta-analysis

BackgroundProcalcitonin (PCT) has garnered attention as a potential diagnostic biomarker for infection in cancer patients. We performed a systematic review and meta-analysis to evaluate the diagnostic accuracy of procalcitonin (PCT) and to compare it with C‐reactive protein (CRP) in adult non-neutropenic cancer patients with suspected infection.MethodsA systematic literature search was performed in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials to identify all relevant diagnostic accuracy studies. Original articles reporting the diagnostic accuracy of PCT for infection detection in adult patients with solid or hematological malignancies were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, area under the hierarchical summary receiver operator characteristic (HSROC) curve, and corresponding 95% confidence interval (CI) were calculated.ResultsSeven studies were included in the meta-analysis. The pooled sensitivity and specificity of PCT were 60% (95% CI [45–74%]) and 78% (95% CI [69–86%]). The diagnostic odds ratio was estimated at 5.47 (95% CI [2.86–10.46]). Three studies compared the diagnostic accuracies of PCT and CRP. The pooled sensitivity and specificity values for PCT were 57% (95% CI [26–83%]) and 75% (95% CI [68–82%]), and those for CRP were 67% (95% CI [35–88%]) and 73% (95% CI [69–77%]). The pooled sensitivity and specificity of PCT and CRP did not differ significantly (p = 0.61 and p = 0.63). The diagnostic accuracy of PCT was similar to that of CRP as measured by the area under the HSROC curve (0.73, CI = 0.61–0.91 vs. 0.74, CI = 0.61–0.95, p = 0.93).ConclusionWhile elevated PCT levels can be indicative of potential infection, they should not be solely relied upon to exclude infection. We recommend not using the PCT test in isolation; Instead, it should be carefully interpreted in the context of clinical findings.

Procalcitonin for the diagnosis of postoperative bacterial infection after adult cardiac surgery: a systematic review and meta-analysis

Background and aimsPatients undergoing cardiac surgery are subject to infectious complications that adversely affect outcomes. Rapid identification is essential for adequate treatment. Procalcitonin (PCT) is a noninvasive blood test that could serve this purpose, however its validity in the cardiac surgery population is still debated. We therefore performed a systematic review and meta-analysis to estimate the accuracy of PCT for the diagnosis of postoperative bacterial infection after cardiac surgery.MethodsWe included studies on adult cardiac surgery patients, providing estimates of test accuracy. Search was performed on PubMed, EmBase and WebOfScience on April 12th, 2023 and rerun on September 15th, 2023, limited to the last 10 years. Study quality was assessed with the QUADAS-2 tool. The pooled measures of performance and diagnostic accuracy, and corresponding 95% Confidence Intervals (CI), were calculated using a bivariate regression model. Due to the variation in reported thresholds, we used a multiple-thresholds within a study random effects model for meta-analysis (diagmeta R-package).ResultsEleven studies were included in the systematic review, and 10 (2984 patients) in the meta-analysis. All studies were single-center with observational design, five of which with retrospective data collection. Quality assessment highlighted various issues, mainly concerning lack of prespecified thresholds for the index test in all studies. Results of bivariate model analysis using multiple thresholds within a study identified the optimal threshold at 3 ng/mL, with a mean sensitivity of 0.67 (0.47–0.82), mean specificity of 0.73 (95% CI 0.65–0.79), and AUC of 0.75 (IC95% 0.29–0.95). Given its importance for practice, we also evaluated PCT’s predictive capability. We found that positive predictive value is at most close to 50%, also with a high prevalence (30%), and the negative predictive value was always > 90% when prevalence was < 20%.ConclusionsThese results suggest that PCT may be used to help rule out infection after cardiac surgery. The optimal threshold of 3 ng/mL identified in this work should be confirmed with large, well-designed randomized trials that evaluate the test’s impact on health outcomes and on the use of antibiotic therapy.PROSPERO Registration number CRD42023415773. Registered 22 April 2023.Graphical abstract

Accuracy of procalcitonin for diagnosing sepsis in adult patients admitted to the emergency department: a systematic review and meta-analysis.

Differentiating sepsis from non-infectious systemic inflammatory response syndrome (SIRS) is challenging. Biomarkers like procalcitonin (PCT) aid early risk assessment and guide antibiotic use. This study aims to ascertain PCT's accuracy as a sepsis biomarker among adult emergency department admissions. The PRISMA guidelines were followed to search for relevant articles in five electronic databases between April 14th and August 4th, 2023: PubMed, Cochrane Library, ProQuest, EMBASEs, and ScienceDirect. Studies had to be published in English to avoid directly translating scientific terms. Besides, the inclusion criteria were based on the diagnosis of sepsis in adult patients admitted to an emergency department. QUADAS-2 tool provided by the Review Manager version 5.4.1 was utilized to assess the risk of bias in included studies. STATA (v. 16) software was used to perform the meta-analysis. Ten of 2457 studies were included. We sampled 2980 adult sepsis patients for the under-investigated role of PCT in ED sepsis diagnosis. PCT emerged as the primary early diagnostic biomarker with high levels (29.3 ± 85.3ng/mL) in sepsis patients. Heterogeneity in outcomes, possibly due to bias in cohort and observational studies, was observed. PCT tests offer moderate accuracy in diagnosing sepsis and stand out for rapidly and precisely distinguishing between viral and bacterial inflammations.

Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review

Obtaining blood cultures (HC) is performed in 15% of the patients treated with suspicion of infection in the Hospital Emergency Services (ED) with a variable diagnostic yield (2-20%). The 30-day mortality of patients with bacteremia is two or three times higher than the rest with the same process. Procalcitonin (PCT) is a biomarker that has been used as a tool to help predict bacteremia in HEDs. The main objective of this systematic review is to investigate the diagnostic accuracy of PCT in predicting true bacteraemia in adult patients treated with clinical suspicion of infection in the ED, as well as to identify a specific PCT value as the most relevant from the clinical decision diagnostic point of view that can be recommended for decision making. A systematic review was performed following the PRISMA guidelines in the PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov databases from January 2010 to May 31, 2023 without language restrictions and using a combination of MESH terms: "Bacteremia/ Bacteraemia/ Blood Stream Infection", "Procalcitonin", "Emergencies/ Emergency/ Emergency Department" and "Adults". Observational cohort studies and partially an systematic review were included. No meta-analysis techniques were performed, but the results were compared narratively. A total of 1,372 articles were identified, of which 20 that met the inclusion criteria were finally analyzed. The included studies represent a total of 18,120 processed HC with 2,877 bacteraemias (15.88%). Ten studies were rated as high, 9 moderate and 1 low quality. The AUC-COR of all the studies ranges from 0.68 (95% CI: 0.59-0.77) to 0.98 (95% CI: 0.97-0.99). The PCT value >0.5 ng/ml is the most widely used and proposed in up to ten of the works included in this systematic review, whose estimated mean yield is an AUC-COR of 0.833. If only the results of the 6 high-quality studies using a cut-off point (PC) >0.5 ng/mL PCT are taken into account, the estimated mean AUC-COR result is 0.89 with Se of 77.6% and It is 78%. PCT has a considerable diagnostic accuracy of bacteraemia in patients treated in EDs for different infectious processes. The CP>0.5 ng/ml has been positioned as the most suitable for predicting the existence of bacteraemia and can be used to reasonably rule it out.

The Procalcitonin Combined with C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Patients After Lung Transplantation

BackgroundThe Procalcitonin (PCT) and C-reactive protein (CRP)/albumin ratio have recently been used to predict early prognosis for intensive care unit (ICU) patients and patients undergoing major surgery. But there were few clinical studies in patients after lung transplantation (LTX).Aim/PurposeThe purpose of this study was to identify the association between PCT combined with CRP/albumin ratio and 30-day mortality and predict the accuracy of PCT combined with CRP/albumin ratio for 30-day mortality in patients after LTX.MethodFrom January 1, 2016 to December 1, 2020, the clinical data of 77 patients undergoing LTX who died within 30 days were retrospectively collected, we randomly collected 87 patients survived more than 30 days after LTX. ROC curve was used to evaluate the prognostic value of PCT combined with CRP/albumin in predicting mortality at 30 days after ICU admission, Cox proportional hazard model analysis was used to identify risk factors, subgroup analyses was conducted.ResultsPostoperative PCT, CRP, albumin, CRP/albumin ratio, atrial fibrillation, primary graft dysfunction (PGD) grade, the hours of postoperative mechanical ventilation (MV) and length of ICU stay between survivor and non-survivor had a significant difference. On Cox proportional hazard regression analysis, both PCT [HR 1.02 (1.00–1.05), P = 0.037] and CRP/albumin ratio [HR 1.438 (1.26–1.65), P < 0.001] were independent predictors of 30-day mortality. In all patients after LTX, the area under the curve (AUC) of PCT combined with CRP/albumin ratio for predicting 30-day mortality was 0.76 (95% CI 0.69–0.83). In subgroup analysis, the AUC of PCT combined with CRP/albumin ratio for predicting 30-day mortality was 0.83 (95% CI 0.75–0.91) in patients undergoing LTX for interstitial pulmonary fibrosis (IPF).ConclusionThe PCT combined with CRP/albumin ratio could be a predictor of the outcomes in patients undergoing LTX. The predictive efficacy was better in patients undergoing LTX for IPF.

The utility of procalcitonin for diagnosing bacteremia and bacterial pneumonia in hospitalized oncology patients.

Procalcitonin (PCT) is an inflammatory marker elevated in bacteremia and bacterial pneumonia. We aimed to assess the real-world diagnostic accuracy of PCT in hospitalized patients with malignancy. A retrospective cohort of 715 patients with cancer who had PCT measured during 750 admissions was analyzed. Diagnosis of bacteremia was determined using blood culture data. Diagnosis of bacterial pneumonia was based on radiographic infiltrate and/or sputum culture. PCT's performance was assessed using receiver operating characteristic (ROC) curves, sensitivity, and specificity. Patients had bacteremia, bacterial pneumonia, or both during 210 admissions (28%). PCT elevation above 0.5ng/mL was significantly associated with diagnosed infection in the overall population (p < 0.0001) and in subgroups with solid tumor malignancies (p < 0.0001) and hematologic malignancies (p = 0.008). PCT was associated with infectious status in patients with any metastases, but not those with primary lung cancer, lung metastases, neuroendocrine tumors, febrile neutropenia, or history of bone marrow transplant (BMT). The area under the ROC curve for PCT in the overall population was 0.655. An ideal cutoff of 0.21ng/mL led to a sensitivity of 60% and specificity of 59%. At cutoffs of 0.5ng/mL and 0.05ng/mL, PCT's sensitivity was 39% and 94%, while specificity was 79% and 17%, respectively. In this large cohort of hospitalized oncology patients, PCT elevation was associated with diagnosed bacteremia and/or bacterial pneumonia. However, specificity was limited, and PCT elevation was not associated with diagnosed infection in some subpopulations. While PCT may have some diagnostic utility for hospitalized oncology patients, values must be interpreted cautiously and considering clinical context.

Diagnostic accuracy of procalcitonin and interleukin-6 for postoperative infection in major gastrointestinal surgery: a systematic review and meta-analysis.

We aim to assess the diagnostic accuracy of procalcitonin (PCT) and interleukin-6 (IL-6) as diagnostic biomarkers for postoperative infection/sepsis following major abdominal surgery. Postoperative infection is an important cause for morbidity and mortality in major surgery. Early diagnosis and antimicrobial treatment improves outcomes, and high-performing biomarkers could guide clinical decision making. A systematic database search was conducted for studies reporting diagnostic performance of biomarkers (including PCT and IL-6) for infection/sepsis following major abdominal surgery. Studies were assessed for reporting of diagnostic accuracy, relevance and quality. Data were extracted for meta-analysis. Ten studies with 1,611 participants reported the diagnostic accuracy of PCT, with pooled sensitivity, specificity and summary receiver operator curve of 72% (95% CI 66-78), 62% (95% CI 59-64) and 0.766, respectively. Four studies with 175 participants reported the diagnostic accuracy of IL-6, with pooled sensitivity, specificity and summary receiver operator curve of 84% (95% CI 72-92), 76% (95% CI 68-84) and 0.878, respectively There was variability in the timing of sampling and cut-off values and significant heterogeneity and inconsistency between studies (I2 diagnostic odds ratio (DOR)= 43.2% for PCT, I2 DOR=0% for IL-6). PCT performs only moderately well as a diagnostic test for postoperative infection/sepsis in major abdominal surgery, demonstrating limited sensitivity and specificity. Heterogeneity between studies is a limitation of the meta-analysis. There is an ongoing need for a rapid, accurate biomarker for postoperative infection or sepsis.

Diagnostic Accuracy of Procalcitonin upon Emergency Department Admission during SARS-CoV-2 Pandemic.

HighlightsProcalcitonin has low sensitivity for bacterial pneumonia at emergency admission.Procalcitonin has low specificity for bacterial pneumonia at emergency admission.Procalcitonin sampled at emergency admission should not guide antibiotic prescriptions.Higher procalcitonin values in COVID-19 pneumonia hinder its use for antibiotic stewardship.No procalcitonin cutoff level provided reliable guidance in antibiotic prescription.Introduction: Procalcitonin is a marker for bacterial diseases and has been used to guide antibiotic prescription. Procalcitonin accuracy, measured at admission, in patients with community-acquired pneumonia (CAP), is unknown in the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Objectives: To evaluate the diagnostic accuracy of procalcitonin to assess the need for antibiotic treatment in patients with CAP presenting to the emergency department during the SARS-CoV-2 pandemic. Methods: We performed a real-world diagnostic retrospective accuracy study of procalcitonin in patients admitted to the emergency department. Measures of diagnostic accuracy were calculated based on procalcitonin results compared to the reference standard of combined microbiological and radiological analysis. Sensitivity, specificity, positive and negative predictive values, and area under (AUC) the receiver-operating characteristic (ROC) curve were calculated in two analyses: first assessing procalcitonin ability to differentiate microbiologically proven bacteria from viral CAP and then clinically diagnosed bacterial CAP from viral CAP. Results: When using a procalcitonin threshold of 0.5 ng/mL to identify bacterial etiology within patients with CAP, we observed sensitivity and specificity of 50% and 64.1%, and 43% and 82.6%, respectively, in the two analyses. The positive and negative predictive values of a procalcitonin threshold of 0.5 ng/mL to identify patients for whom antibiotics should be advised were 46.4% and 79.7%, and 48.9% and 79% in the two analyses, respectively. The AUC for the two analyses was 0.60 (95% confidence interval [CI] 0.52–0.68) and 0.62 (95% CI, 0.55–0.69). Conclusions: Procalcitonin measured upon admission during the SARS-CoV-2 pandemic should not guide antibiotic treatment in patients with CAP.

Systematic review and meta-analysis assessing the diagnostic test accuracy of procalcitonin in the diagnosis of invasive bacterial infections in febrile infants: a study protocol

IntroductionYoung febrile infants are at higher risk of invasive bacterial infections (IBIs) compared with older children. The clinical features of IBI are subtle in this cohort mandating that clinicians take...

Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin for post-operative sepsis/infection in liver transplantation

BackgroundPost-operative infection is a major cause of morbidity and mortality in Liver Transplantation (LT). Early diagnosis and antimicrobial treatment improves outcomes and ruling out sepsis aids immunosuppression decisions. Procalcitonin (PCT) has recently become part of such decision making in COVID-19 pneumonia but its role in LT is not established. We assessed the diagnostic accuracy of PCT as a diagnostic biomarker for infection or sepsis following LT. MethodsA systematic search was conducted for studies reporting diagnostic performance of PCT for infection/sepsis following LT. Studies were assessed for reporting of diagnostic accuracy, relevance and quality. ResultsEight studies with 363 participants reported data on the diagnostic accuracy of PCT, with pooled sensitivity, specificity, diagnostic odds ratio and summary receiver operator curve of 70% (95% CI 62–78), 77% (95% CI 73–83), 15.82 (95% CI 5.82–43.12) and 0.871 respectively. There was variability in the timing of sampling (post-operative day 1–8) and range of cut-off values (0.48 to 42.8 ng/mL). Heterogeneity was reduced when only studies with adult LT recipients were considered. ConclusionsPCT performs moderately well as a diagnostic test for postoperative infection/sepsis following LT. This marker is more suited for use in adult LT populations.

Diagnostic value of procalcitonin for bacterial infections in patients undergoing hemodialysis: a systematic review and meta-analysis

Background The diagnostic value of procalcitonin (PCT) in patients undergoing hemodialysis (HD) remains unclear. Methods We searched multiple databases (PubMed, EMBASE, and Cochrane Library) for studies published through August 2021 that evaluated the diagnostic performance of PCT in patients undergoing HD and having suspected bacterial infections. The bivariate fixed effects model was used to calculate pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and summary receiver operating characteristic (SROC) curves. Results We identified a total of 1799 studies, of which seven diagnostic studies comprised 1444 patients and 430 bacterial infection episodes. Bivariate pooled sensitivity and specificity for PCT were 0.90 (95% CI: 0.85–0.94) and 0.83 (95% CI: 0.56–0.95), respectively. Furthermore, pooled DOR, PLR, NLR, and area under the curve (AUC) were 47 (95% CI: 11–209), 5.4 (95% CI: 1.7–16.9), 0.12 (95% CI: 0.07–0.20), and 0.92 (95% CI: 0.90–0.94), respectively. We also compared the diagnostic accuracy of PCT and C-reactive protein (CRP), and our results showed that the diagnostic accuracy parameters for PCT were significantly higher than those for CRP. Conclusions PCT is a useful marker for diagnosis of bacterial infections in patients undergoing HD at a cutoff value of 1.5 ng/ml.

Accuracy of procalcitonin in identifying patients presenting with diabetic ketoacidosis as a result of an infectious etiology

Accuracy of procalcitonin in identifying patients presenting with diabetic ketoacidosis as a result of an infectious etiology

Post-operative serum procalcitonin vs. C-reactive protein as a marker of post-operative infectious complications in pancreatic surgery: A systemic review and meta-analysis

The aim of this meta-analysis was to compare the diagnostic accuracy of C-reactive protein (CRP) and Procalcitonin (PCT) between postoperative days (POD) 3 to 5 in predicting infectious complications post pancreatic surgery. A systemic literature search was performed using MEDLINE, EMBASE, and SCOPUS to identify studies evaluating the diagnostic accuracy of PCT and CRP as a predictor for detecting infectious complications between POD 3 to 5 following pancreatic surgery. A meta-analysis was performed using the random-effect model and pooled predictive parameters. Geometric means were calculated for PCT cut-offs. After applying inclusion and exclusion criteria 15 studies consisting of 2,212 patients were included in the final analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled sensitivity, specificity, Area under the curve, and diagnostic odds ratio (DOR) for day 3 CRP were respectively 62%,67% 0.772, and 6.54. Pooled sensitivity, specificity, Area under the curve, and DOR for day 3 PCT was respectively 74%,79%, 0.8453, and 11.03. Sensitivity, specificity, Area under the curve and DOR for day 4 CRP were respectively 60%, 68%, 0.8022, and 11.90. Pooled sensitivity, specificity, and DOR of postoperative day 5 PCT level in predicting infectious complications were respectively 83%,70%, and 12.9. Pooled sensitivity, specificity, Area Under a ROC Curve, and diagnostic odds ratio were respectively 50%, 70%, 0.777, and 10.19. Post-operative PCT is better marker to predict post-operative infectious complications after pancreatic surgeries and post-operative day 3 PCT has highest diagnostic accuracy.

The Diagnostic Utility of Procalcitonin for the Detection of Infection among Systemic Lupus Erythematosus Patients in a Tertiary Care Hospital

Background: Clinical manifestations of infection in patients with systemic lupus erythematosus (SLE) are variable and involve significant diagnostic challenges. Delays in diagnosis and treatment strongly affect the clinical outcomes and mortality. The elevation of one’s serum procalcitonin (PCT) level may be a diagnostic biomarker of infection in SLE. Objective: To determine the diagnostic accuracy of PCT for bacterial and fungal infections in patients with SLE. Materials and Methods: Samples of serum PCT were prospectively collected in all patients with SLE admitted to medical wards at Siriraj Hospital, a tertiary care center, between February 2011 and March 2012. Results: One hundred twenty-four patients with SLE were enrolled. The mean age was 31.9±10.9 years. The median disease duration of SLE was five years. The Median Mexican SLE Disease-Activity Index Score was 8 (IQR 6 to 11.8). Ninety-five percent of patients had active SLE and 70% of them were treated with prednisolone of more than 15 mg/day or equivalent doses of other corticosteroids. The serum PCT levels of SLE patients with infection (n=39; median 0.52 ng/mL, IQR 0.15 to 1.49) were significantly increased, compared to those of SLE patients with no infection (n=85; median 0.09 ng/mL, IQR 0.04 to 0.16), p&lt;0.001. The cut-off point of elevated serum PCT (0.5 ng/mL) for the diagnosis of bacterial or fungal infections in patients with SLE had sensitivity, specificity, positive predictive value, and negative predictive values of 51.3%, 95.3%, 83.3%, and 81%, respectively. The independent factors associated with elevated serum PCT levels of 0.5 ng/mL or more were the presence of a bacterial or fungal infection, a low hemoglobin level, and serum Cr of 2 mg/dL or more. Conclusion: The elevation of one’s serum PCT level may be a useful biomarker to detect bacterial and fungal infections in patients with SLE. Keywords: Systemic lupus erythematosus; Procalcitonin; Sensitivity; Specificity; Infection; Sepsis; Flare

Procalcitonin and Early Postoperative Infection After Pediatric Cardiopulmonary Bypass Surgery

Systemic inflammation and bacterial infections are critical occurrences after pediatric cardiac surgery. Elevated white blood cell count and C-reactive protein cannot discriminate between these two conditions in the early postoperative period. The aim of this study was to understand whether procalcitonin (PCT) values within 48 hours of surgery could be a useful marker of postoperative infection. Retrospective observational study. The study was performed in a teaching hospital. All patients ≤six years of age. Cardiac surgery on cardiopulmonary bypass from January 1, 2017 to January 1, 2020. PCT, white blood cell count, and C-reactive protein values were measured at intensive care unit admission and at 24 and 48 hours after surgery. All positive cultures in the first seven days after surgery were recorded. Out of 177 consecutive patients, 22 (12%) developed infections. PCT at 48 hours after surgery was the only laboratory predictor of infections in the first seven days after surgery (p=0.02). Receiver operating curve analyses on PCT values at 48 hours identified an optimal cut-off value of 1.85 ng/mL in the overall population. Area under the curve was 0.63, sensitivity 63%, and specificity 69%. In light of this preliminary result, the clinical relevance and predictive accuracy of PCT are promising in patients with increasing values of PCT but need to be confirmed in a larger sample.

Diagnostic Accuracy of Serum Procalcitonin (PCT) as an Early Biomarker of Neonatal Sepsis using Blood Culture as Gold Standard.

To ascertain the diagnostic accuracy of serum PCT as an early biomarker of neonatal sepsis using blood culture as gold standard, so that the condition could be diagnosed and managed early to prevent and reduce morbidity and mortality in neonates. Study Design: Cross-sectional study. Dr. Ziauddin University Hospital, Karachi, from March 2019 to December 2019. A total of 171 neonates, 1-29 days of age, presented with clinical diagnosis of neonatal sepsis, were included in this study. Patients' data regarding age, gender, birth weight, prematurity and premature rupture of membranes (PROM) were collected. Blood cultures were performed in Microbiology Department; and Serum PCT was analyzed on Electrochemiluminescence Immunnoassay Analyzer (Cobas e601). Diagnostic accuracy, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PCT were calculated with contingency tables using blood culture findings as gold standard. Out of 171 clinically diagnosed cases of neonatal sepsis, 86 (50.3%) were confirmed as having neonatal sepsis (blood culture positive). There was a significant difference in serum PCT levels in both the groups. The sensitivity of PCT was 97.7%; specificity 70.6%; PPV 77.1; NPV 96.8%; likelihood ratio of a positive test (LR+ve) 3.32; likelihood ratio of a negative test (LR -ve) 0.03, and cumulative diagnostic accuracy of PCT 84.2%. PCT is a very useful biomarker for the early diagnosis of neonatal sepsis, showing 84.2% diagnostic accuracy. Thus PCT can help in making early clinical decisions regarding management of patients. Key Words: Diagnostic accuracy, PCT, Neonatal sepsis.

Meta-analysis of procalcitonin as a predictor for acute kidney injury.

Background:Procalcitonin (PCT) was used for predicting the development of acute kidney injury (AKI) in several studies recently. We aimed to investigate the accuracy of PCT for predicting AKI in this study.Methods:Studies that assessed the predictive performance of PCT for the development of AKI in adult patients were searched from Medline, Embase, and the Cochrane Library from inception to June 2020. We calculated the pooled sensitivities and specificities and the area under the summary receiver-operating characteristic (SROC) curves. I2 was used to test the heterogeneity and the potential heterogeneity was investigated by meta-regression.Results:In total, 9 of 119 studies with 4852 patients were included, 1272 were diagnosed with AKI. In the overall analysis, the area under the SROC curve was 0.82 (95% CI, 0.79–0.85) and the pooled sensitivity and specificity were 0.76 (95% confidence interval [CI], 0.64–0.85) and 0.75 (95% CI, 0.61–0.86), respectively. In the subgroup analysis among septic patients, the pooled sensitivity and specificity were 0.59 (95% CI, 0.29–0.84) and 0.53 (95% CI, 0.31–0.74), and the area under the SROC was 0.57 (95% CI, 0.53–0.62).Conclusion:PCT may be a potential predictor for the development of AKI.

Diagnostic Accuracy of Clinical Tool 'STOPS' and Serum Procalcitonin for Optimizing Antibiotic Therapy in Neonates Born at ≥ 28 Weeks of Gestation with Neonatal Sepsis.

BackgroundAntibiotic therapy is initiated in neonates on suspicion of sepsis. Optimizing therapy is a felt need of clinicians as prolonged injudicious use increases mortality and morbidity risk.ObjectiveTo evaluate the diagnostic accuracy of clinical tool 'STOPS' and serum procalcitonin (PCT) for identifying neonates with early-onset neonatal sepsis (EONS) or late-onset neonatal sepsis (LONS) and early discontinuation in those with no sepsis.MethodsThe study had a prospective analytical design conducted at a tertiary care hospital. Consecutively admitted neonates with suspected EONS or LONS were enrolled. The 'STOPS' tool comprising sensorium, temperature, oxygenation, perfusion, skin color, and blood sugar was applied at 6 and 12 hours of enrollment. Serum PCT was sent at 12 hr. The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (PLR and NLR) were estimated.ResultsThe study enrolled 380 neonates, of which 330 were given antibiotics for EONS and 50 for LONS. Temperature disturbance in the EONS group at 12 hr showed a PPV of 100% and a PLR of 9.1 (7.7 – 18). Perfusion assessment at 12 hr had a PPV of 77% and PLR of 8.25 (2.3 – 29). Skin color assessment at 12 hr had a PPV of 100% and PLR of 13.5 (9.7 – 27). The diagnostic accuracy of PCT in the EONS group was unremarkable. In the LONS group, skin color at 12 hr had a PPV of 100% and PLR of 11.2 (8.6 – 19.5). The diagnostic accuracy of PCT in the LONS group showed a PPV of 82% and PLR of 7 (1.7 – 29).ConclusionIdentifying abnormal STOPS parameters was superior to PCT alone in EONS and as good as PCT in LONS. The 'STOPS' tool allows early identification of neonates with no sepsis, thereby optimizing antibiotic use.

What is the accuracy of procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) for the diagnosis of acute pyelonephritis in children?

What is the accuracy of procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) for the diagnosis of acute pyelonephritis in children?